Lueker, Jakob, Kuhr, Kathrin, Sultan, Arian, Noelker, Georg, Omran, Hazem ORCID: 0000-0001-7342-3686, Willems, Stephan, Andrie, Rene, Schrickel, Jan W., Winter, Stefan, Vollmann, Dirk ORCID: 0000-0002-3679-1700, Tilz, Roland R., Jobs, Alexander, Heeger, Christian-H., Metzner, Andreas, Meyer, Sven, Mischke, Karl, Napp, Andreas, Fahrig, Andreas, Steinhauser, Susanne, Brachmann, Johannes, Baldus, Stephan, Mahajan, Rajiv, Sanders, Prashanthan ORCID: 0000-0003-3803-8429 and Steven, Daniel (2019). Internal Versus External Electrical Cardioversion of Atrial Arrhythmia in Patients With Implantable Cardioverter-Defibrillator A Randomized Clinical Trial. Circulation, 140 (13). S. 1061 - 1070. PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 1524-4539

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Abstract

Background: Atrial arrhythmias are common in patients with implantable cardioverter-defibrillator (ICD). External shocks and internal cardioversion through commanded ICD shock for electrical cardioversion are used for rhythm-control. However, there is a paucity of data on efficacy of external versus internal cardioversion and on the risk of lead and device malfunction. We hypothesized that external cardioversion is noninferior to internal cardioversion for safety, and superior for successful restoration of sinus rhythm. Methods: Consecutive patients with ICD undergoing elective cardioversion for atrial arrhythmias at 13 centers were randomized in 1:1 fashion to either internal or external cardioversion. The primary safety end point was a composite of surrogate events of lead or device malfunction. Conversion of atrial arrhythmia to sinus rhythm was the primary efficacy end point. Myocardial damage was studied by measuring troponin release in both groups. Results: N=230 patients were randomized. Shock efficacy was 93% in the external cardioversion group and 65% in the internal cardioversion group (P<0.001). Clinically relevant adverse events caused by external or internal cardioversion were not observed. Three cases of pre-existing silent lead malfunction were unmasked by internal shock, resulting in lead failure. Troponin release did not differ between groups. Conclusions: This is the first randomized trial on external vs internal cardioversion in patients with ICDs. External cardioversion was superior for the restoration of sinus rhythm. The unmasking of silent lead malfunction in the internal cardioversion group suggests that an internal shock attempt may be reasonable in selected ICD patients presenting for electrical cardioversion.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Lueker, JakobUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kuhr, KathrinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sultan, ArianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Noelker, GeorgUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Omran, HazemUNSPECIFIEDorcid.org/0000-0001-7342-3686UNSPECIFIED
Willems, StephanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Andrie, ReneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schrickel, Jan W.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Winter, StefanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Vollmann, DirkUNSPECIFIEDorcid.org/0000-0002-3679-1700UNSPECIFIED
Tilz, Roland R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jobs, AlexanderUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Heeger, Christian-H.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Metzner, AndreasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Meyer, SvenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mischke, KarlUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Napp, AndreasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fahrig, AndreasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Steinhauser, SusanneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Brachmann, JohannesUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Baldus, StephanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mahajan, RajivUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sanders, PrashanthanUNSPECIFIEDorcid.org/0000-0003-3803-8429UNSPECIFIED
Steven, DanielUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-133737
DOI: 10.1161/CIRCULATIONAHA.119.041320
Journal or Publication Title: Circulation
Volume: 140
Number: 13
Page Range: S. 1061 - 1070
Date: 2019
Publisher: LIPPINCOTT WILLIAMS & WILKINS
Place of Publication: PHILADELPHIA
ISSN: 1524-4539
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
CARDIAC RESYNCHRONIZATION THERAPY; HEART-FAILURE; RHYTHM CONTROL; FIBRILLATION; PACEMAKER; EFFICACY; MANAGEMENT; REGISTRY; DEVICE; SAFETYMultiple languages
Cardiac & Cardiovascular Systems; Peripheral Vascular DiseaseMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/13373

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